African Journal of Biotechnology Vol. 2 (12), pp. 657-661, December 2003 Available online at http://www.academicjournals.org/AJB ISSN 1684–5315 © 2003 Academic Journals Minireview About Trypanosoma brucei gambiense, the causative agent of the chronic form of Human African Trypanosomiasis: some findings and proposals P. Truc 1,2 1Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), Department of Research and Control of Human African Trypanosomiasis, BP 288, Yaounde, Cameroon. 2Institut de Recherche pour le Développement, IRD, Research Unit 35 BP 1857, Yaounde, Cameroon. E-mail: [email protected], Tel: + 237 984 60 57. Accepted 20 November 2003 Since its discovery at the beginning of 20th century, Human African Trypanosomiasis or sleeping sickness has killed several hundred thousands of individuals in Africa, mainly in Central part of the continent. The actual situation of the disease in several countries is dramatic, such as in Sudan, Democratic Republic of Congo or Angola. However, diagnosis is still based on the detection of parasites in blood or lymphatic juice by microscopy, like in 1930's. Furthermore, since the discovery of melarsoprol in 1949, no novel drugs have been synthesized for treatment. This must consider it within the whole context of "most-neglected diseases" but some findings obtained through biotechnology are discussed in terms of epidemiology and control applications. Key words: Human African Trypanosomiasis, neglected disease, biotechnologies. Nowadays, sleeping sickness or Human African gambiense. This parasite is transmitted by vector, tsetse Trypanosomiasis (HAT) is considered to be one of “the flies, most of which belong to the species Glossina most-neglected diseases”, in terms of drug development palpalis. Since the discovery of this pathology at the and continues to plague Africa (Morel, 2003). World beginning of 20th century (e.g. Bruce and Nabarro, 1903), Health Organization estimates that about 600,000 HAT has killed several hundred thousands of individuals persons are currently infected, most of them in Central in Africa, mainly in Central part of the continent (Martin et Africa. The chronic form of HAT is a lethal disease al., 1909; W.H.O., 1998). Although the epidemic of 1920- caused by a parasite named Trypanosoma brucei 1930’s was successfully controlled thanks to Dr. Jamot 658 Afr. J. Biotechnol. and mobile medical teams surveys, especially in observed due to the presence of anti-trypanosome Cameroon between 1928 and 1930, the actual situation antibodies in blood. Therefore, CATT/T. b. gambiense of the disease in several countries is dramatic, such as in allowed mass screening, but parasite detection was Sudan, Democratic Republic of Congo or Angola. Many required in blood or lymph node aspirate. Today, the research teams have tried to improve our knowledge of CATT/T. b. gambiense is the usual test for mass the epidemiology, pathogenicity and genetics of HAT for screening, but its specificity is low because false positive about 40 years, using sophisticated tools for diagnosis, results caused by others pathologies such as malaria. isolation and characterization of trypanosomes. However, CATT/T. b. gambiense is still being evaluated despite the absence of operational therapeutic alternatives many previous studies and simplification of this test or appears to be in contradiction with all the research alternative version such as a version using Latex activities mentioned above (this list is not exhaustive monoclonal antibodies or a micro-method using filter unfortunately). Thus, although biotechnologies are useful, paper for blood collection named micro-CATT (e.g. for example, to confirm different pathogenic forms of HAT Jamonneau et al., 2000c; Truc et al., 2002a). Again, (genetic distinction between T. b. gambiense and T. b. considering the lack of new drugs and despite rhodesiense, the agent of acute form of the disease), the improvement of diagnosis tools for many other diseases, existence of an animal reservoir, the identification of HAT/T. b. gambiense diagnosis is still based on parasite infected flies, most of the current knowledge on the detection like in 1930’s. epidemiology of HAT was known 70 years ago (see The use of the anion exchange cellulose Mulligan, 1970). Moreover, diagnosis is still based on the chromatography was a major finding for studying detection of parasites in blood or lymphatic juice by trypanosomes (Lanham and Godfrey, 1970). Indeed, the microscopy, as during the time of Dr. Jamot in 1930’s. low number of bloodstreams forms (BSF) (T. b. Indeed, about 70 years ago, HAT specialists already gambiense) and their low virulence when inoculated to knew that a chronic form occurred in West and Central rodents were limiting factors for biological and genetic Africa while an acute form was spreading in East Africa. studies. Although chromatography was used for Even the main drug used by Dr. Jamot, Tryparsamide, concentration of trypanosomes from blood, it has been was chemically an arsenic derivative, like melarsoprol, adapted for diagnosis in the field (miniature anion- discovered by Friedheim in 1949 (see Dumas et al., exchange centrifugation technique, mAECT; Lumsden et 1999). Since then, few novel drugs have synthesized, al., 1979). The mAECT is used in several countries. mostly chance discoveries of compounds initially Before 1979, the traditional techniques for microscopic intended to treat cancer, Ornidyl (Dl- examination of blood for trypanosomes detection were difluoromethylornithine) or Chagas disease, Lampit based on thin, wet or thick blood films with a sensitivity of (nifurtimox). Both of these drugs are used for the 33-17 trypanosomes per ml of blood, while mAECT treatment of second stage of HAT or after treatment detected 3-4 trypanosomes per ml of blood. An individual failure when using melarsoprol (see the review by Van is declared infected by sleeping sickness when parasite Nieuwenhove, 1999). is detected either in blood or lymph node aspirate (WHO, This is reality, but we must consider it within the whole 1998). Thus, a better detection of parasites using mAECT context of “most-neglected diseases” and discuss some was a major improvement for control activities. Other findings obtained through biotechnology. A review on this concentration techniques were proposed, such as subject has been published by Dumas and colleagues Capillary Tube Centrifugation technique or CTC (Woo, (1999). Drugs and therapy will not be discussed because 1970), the Quantitative Buffy Coat or QBC (Bailey and since the introduction of Atoxyl in 1904, the ideal Smith, 1992) but, unfortunately, some national control antitrypanosomal drug, which is cheap, effective in early programs in Africa can only perform microscopic and advanced sleeping sickness, of low toxicity, with a examination of thick or wet blood films for financial long duration of action after oral absorption and not reasons and/or lack of appropriated equipment. Again, rapidly inducing resistance, has yet to be discovered discordance exists, unfortunately, between biotechnology (Van Nieuwenhove, 1999). While some new diamidines and techniques used for control activities. This could (e.g. DB 289, Brun, personal communication), and partially explain why HAT is considered to be one of the combination therapy are under study, none of these is yet “most-neglected diseases”. operational for treatment. Two issues of research will be Following the infective bite by tsetse fly, the classical discussed: first concerning mass screening, diagnostic clinical evolution of HAT in human starts with the and stage determination of patients, second about the haemato-lymphatic or first stage (P1), characterized by epidemiology of the disease (e.g. isolation, biology and only few typical clinical signs (primary lesion or chancre, genetic of trypanosomes). swollen lymph node or Winterbottom’s sign). Then, the In 1978, the Card Agglutination Test for meningo-encephalitic or second stage (P2) occurs due to Trypanosomiasis (CATT/T. b. gambiense; Magnus et al., the presence of trypanosomes in the cerebrospinal fluid 1978) was described. If positive, agglutination was (CSF), leading to the progressive appearance of Truc 659 neurological disorders. The classical stage determination become positive. Again, the mAECT remains the most method is based on CSF cell counting (cut-off, 5 cells/µl), useful technique for diagnostic of HAT, when available. CSF protein concentration (cut-off, 37 mg/100ml by the The genetic identification of trypanosomes was dye-binding protein assay) and/or the presence of performed first by Multi-Locus Enzyme Electrophoresis trypanosomes detected by simple or double MLEE (Godfrey and Kilgour, 1976, Gibson et al., 1980). centrifugation of CSF (WHO, 1998). However the cut-off Restriction Fragment Length Polymorphism of kinetoplast values and the sensitivity of detection of trypanosomes in DNA has been also used to distinguish stocks of T.b. CSF remain doubtful (Truc et al., 1999). On the other gambiense from other sub-species (e.g. Borst et al., hand, clinical examination for detection of neurological 1980). For MLEE, several protocols were described, disorders may contribute to detect a second stage of the using either starch or acetate gel, studying a range of disease but is not satisfactory either (Bisser et al., 2000). metabolic enzymes called isoenzymes (e.g. Gibson et al, However, the appropriate treatment depends on the 1980, Truc et al., 1991). A recent short review has been